FORM WSIA/PDC/1
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
APPLICATION FOR SEWERAGE PLANNING APPROVAL
Date: _______________ 20 ______
To: Sewerage Certifying Agency
I/We ____________________________________________________________________________________________
hereby apply for the approval of the sewerage planning to undertake the following sewerage works/septic tank works*:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Details of land
1. Address/Lot No. of land occupied by sewerage works/septic tank works*:
___________________________________________________________________________________
2. Area of land occupied by sewerage works
(a) Sewage Treatment Plant ___________________ acres
(b) Pumping Station ___________________ acres
(Note: * delete where appropriate)
Details of Population Equivalent (PE)
TYPE TOTAL PE REMARKS
Residential
Commercial
Institutional
Industrial
Others
Total Development PE
FORM WSIA/PDC/1
Declaration by Owner
I _____________________ the owner of the land where the sewerage works/septic tank works* will be carried hereby
agree for said works to be carried out on the land.
Signature of Owner
Name of Owner
(in block letters) :
I.C.No. :
Address :
Telephone No. :
Fax No. :
E-mail :
Declaration by Developer
I hereby declare that the information given are complete, true and accurate and this project/development shall be carried
out in strict compliance with the Water Services Industry Act 2006 and its subsidiary legislations. I accept full responsibility
to ensure all relevant works shall be completed accordingly.
Signature of Developer
Name of Developer
(in block letters) :
I.C.No. :
Address :
Telephone No. :
Fax No. :
E-mail :
(Note: * delete where appropriate)
FORM WSIA/PDC/1
Declaration by Competent Person
I hereby certify that details in this form and all documents attached are complete and accurate. I further certify that the
sewerage planning has been prepared in pursuant to the Water Services Industry (Planning, Design And Construction Of
Sewerage System And Septic Tank) Rules 2013.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C.No :
Address :
Telephone No. :
Fax No. :
E-mail address :
Fee details:
Type of payment : **Bank Draft /Government Cheque
Issuing Bank : ______________________________
Date : ______________________________
Amount : ______________________________
Cheque no. : ______________________________
Validity : ______________________________
(Note: ** delete where appropriate)
FOR OFFICIAL USE ONLY
Receipt No : ______________________________
Reference No. : ______________________________
FORM WSIA/PDC/2
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
APPLICATION FOR SEWERAGE WORKS/SEPTIC TANK WORKS* DESIGN APPROVAL
Date: ___________________ 20____
To: Sewerage Certifying Agency
I___________________________________________________________________________________
hereby apply for the approval of the design to undertake the following sewerage works/septic tank works*:
________________________________________________________________________________________
Declaration by Competent Person
I hereby declare and confirm in accordance with the Statutory Declaration Act 1960 that details in this form and all
documents attached are complete, true and accurate. I further declare that the sewerage planning has been prepared in
pursuant to the Water Services Industry (Planning, Design And Construction Of Sewerage System And Septic Tank) Rules
2013.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C.No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FORM WSIA/PDC/2
Fee details*:
Type of payment : **Bank Draft/Government Cheque
Issuing Bank : ______________________________
Date : ______________________________
Amount : ______________________________
Cheque no. : ______________________________
Validity : ______________________________
Notes:
* Not applicable for septic tank ≤ 5 PE and connection ≤ 10
PE ** delete where appropriate
FOR OFFICIAL USE ONLY
Receipt No : ______________________________
Reference No. : ______________________________
FORM WSIA/PDC/3
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
DETAILS FOR STRUCTURAL PLANS AND DESIGN CALCULATIONS
Date: __________________ 20 ____
To: Sewerage Certifying Agency
I hereby declare in accordance with the Statutory Declaration Act 1960 that the details in the structural plans and design
calculation for the stated sewerage
works:________________________________________________________________
on address/ lot(s):___________________________________________________________________________________ are
complete, true and accurate.
I hereby further declare that these works have been designed by me in accordance with sound engineering practice,
approved design, Malaysian Sewerage Industry Guidelines and Standards and that I take full responsibility for the design
and performance of the same.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C.No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FOR OFFICIAL USE ONLY
Reference No. : ______________________________
FORM WSIA/PDC/4
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
DETAILS FOR ELECTRICAL DESIGN AND DRAWINGS
Date: __________________ 20 ____
To: Sewerage Certifying Agency
I hereby declare in accordance with the Statutory Declaration Act 1960 that the details in the design and drawings for
electrical works for the stated sewerage works:______________________________________________________________
on address/ lot(s):_____________________________________________________________________________________
are complete, true and accurate.
I hereby further declare that the electrical works have been designed by me in accordance with sound engineering practice,
approved design, Malaysian Sewerage Industry Guidelines and Standards and that I take full responsibility for the design
and performance of the same
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C.No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FOR OFFICIAL USE ONLY
Reference No. : ______________________________
FORM WSIA/PDC/5
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
DETAILS FOR EQUIPMENT AND MATERIAL DATA SHEETS (EMDS)
Date: __________________ 20 ____
To: Sewerage Certifying Agency
I hereby declare in accordance with the Statutory Declaration Act 1960 that the installation and details in the equipment and
material data sheet for the stated sewerage works:______________________________________________________
on address/lot(s): ___________________________________________________________________________________
are complete, true and accurate.
I hereby further declare that the mechanical works will be installed in accordance to sound engineering practice and
in accordance to the approved design, Malaysian Sewerage Industry Guidelines and Standards and that I take full
responsibility for the installation and performance of the same.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FOR OFFICIAL USE ONLY
Reference No.: ______________________
FORM WSIA/PDC/6
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
NOTICE OF COMMENCEMENT OF SEWERAGE WORKS/SEPTIC TANK WORKS*
Date: ___________________ 20____
To: Sewerage Certifying Agency
I/We* ______________________ hereby give notice of intention to commence the construction of the sewerage
works/septic tank works* hereinafter described at:
under my supervision that will commence 14 days after the lodgement of this form to Sewerage Certifying Agency. In compliance with
approved sewerage planning and approved design no:____________________________________________
____________________________________________________________________________________________________
(NOTE: *delete where appropriate)
Signature of Competent Person Signature of Permit Holder
Name of Competent Person Name of Permit Holder
(in block letters) : (in block letters) :
I.C. No. : I.C. No. :
Address : Address :
Telephone No. : Telephone No. :
Fax No. : Fax No. :
E-mail address : E-mail address :
SPAN Permit No. :
FORM WSIA/PDC/6
Fee details**:
Type of payment: ***Bank Draft/Government Cheque
Issuing Bank : ______________________________
Date : ______________________________
Amount : ______________________________
Cheque no. : ______________________________
Validity : ______________________________
Note:
* Not applicable for septic tank and connection ≤10 PE
* delete where appropriate
__________________________________________________________________________________________
FOR OFFICIAL USE ONLY
Receipt No : ______________________________
Reference No. : ______________________________
FORM WSIA/PDC/6-1
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
NOTIFICATION FOR CONNECTION TO PUBLIC SEWER
(This notice is to be submitted at least 4 days before connection works to public sewer is made)
To : Indah Water Konsortium Sdn Bhd
Address :
I hereby give notice that the connection works to public sewer will be made on the date, time and location as specified below:
Date (day/month/year) :
Time (am/pm) :
Location :
I take full responsibility to supervise the works in accordance to sound engineering practices and completed in accordance
to approved sewerage planning and approved design in compliance with Water Services Industry (Planning, Design and
Construction of Sewerage System and Septic Tank) Rules 2013 and the requirements of other relevant regulatory
agencies.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FORM WSIA/PDC/6-1
I take full responsibility to supervise the works in accordance to sound engineering practices and completed in accordance
to approved sewerage planning and approved design in compliance with Water Services Industry (Planning, Design and
Construction of Sewerage System and Septic Tank) Rules 2013 and the requirements of other relevant regulatory agencies.
Signature of Permit Holder
Name of Permit Holder
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
SPAN Permit No. :
FORM WSIA/PDC/7
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
NOTICE OF INTERMEDIATE INSPECTION OF SEWERAGE WORKS
Date: _____________20____
To: Sewerage Certifying Agency
I hereby give notice that the sewerage works described below is ready for intermediate inspection.
Description of intermediate inspection of sewerage works to be carried out:-
I hereby agree that all relevant records of the sewerage works testing carried out by me/us will be duly submitted to the
Sewerage Certifying Agency upon the completion of the testing.
I hereby declare in accordance with the Statutory Declaration Act 1960 that the sewerage works has been constructed under
my supervision and the sewerage works has been constructed in pursuant to the approved sewerage planning and approved
design and the Water Services Industry (Planning, Design and Construction of Sewerage System and Septic Tank) Rules
2013.
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
Email address :
FORM WSIA/PDC/7
Fee details:
Type of payment : *Bank Draft /Government Cheque
Issuing Bank : ______________________________
Date : ______________________________
Amount : ______________________________
Cheque no. : ______________________________
Validity : ______________________________
(Note: * delete where appropriate)
FOR OFFICIAL USE ONLY
Receipt No : ______________________________
Reference No. : ______________________________
FORM WSIA/PDC/8
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
NOTICE OF FINAL INSPECTION
Date: _____________20____
To: Sewerage Certifying Agency
I/We hereby give notice that the sewerage works hereafter described and now in the course of construction at:
__________________________________________________________________________________________ has
been completed and is ready for final inspection.
Description of sewerage works:-
_____________________________________________________________________
A. I/We hereby declare in accordance with the Statutory Declaration Act 1960 that the sewerage works has been constructed
under my/our supervision and to the best of my/our knowledge, the work has been constructed in accordance with the
approved sewerage planning and approved design and the Water Services Industry (Planning, Design and Construction
of Sewerage System and Septic Tank) Rules 2013. I/We accept full responsibility for the sewerage works.
B. I/We hereby declare and agree that all relevant records of the sewerage works testing carried out by me/us will be duly
submitted to the Sewerage Certifying Agency upon the completion of the testing.
Signature of Competent Person Signature of Competent Person
(Civil & Structural) (Mechanical & Electrical)
Name of Competent Person Name of Competent Person
(in block letters) : (in block letters) :
I.C. No. : I.C. No. :
Address : Address :
Telephone No. : Telephone No. :
Fax No. : Fax No. :
E-mail address : E-mail address :
FORM WSIA/PDC/8
C. I/We hereby declare in accordance with the Statutory Declaration Act 1960 that the sewerage works has been constructed
in pursuant to the approved sewerage planning and approved design and the Water Services Industry (Planning, Design
and Construction of Sewerage System and Septic Tank) Rules 2013.
(Signature/Stamp) (Signature/Stamp)
Developer : Permit Holder :
Name :
Name : SPAN Permit No. :
Developer’s Expiry date
License No. : of permit :
Fee details:
Type of payment : *Bank Draft/Government Cheque
Issuing Bank : ______________________________
Date : ______________________________
Amount : ______________________________
Cheque no. : ______________________________
Validity : ______________________________
(Note: * delete where appropriate)
FOR OFFICIAL USE ONLY
Receipt No : ______________________________
Reference No. : ______________________________
FORM WSIA/PDC/9
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM AND SEPTIC
TANK) RULES 2013
DECLARATION BY COMPETENT PERSON WHO SUPERVISED THE SEPTIC TANK WORKS
Development : _____________________________________________________
Owner : _____________________________________________________
Drawing No. : _____________________________________________________
Brand & Model of Septic Tank. : _____________________________________________________
I hereby declare in accordance with the Statutory Declaration Act 1960 that all information given in this form is true and
accurate. I further declare that the septic tank is installed in pursuant to the approved sewerage planning and approved
design and the Water Services Industry (Planning, Design and Construction of Sewerage System and Septic Tank) Rules
2013.
Date: ....................................
Signature of Competent Person
Name of Competent Person
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
FOR OFFICIAL USE ONLY
Reference No. : ______________________________
WATER SERVICES INDUSTRY ACT 2006
WATER SERVICES INDUSTRY (PLANNING, DESIGN AND CONSTRUCTION OF SEWERAGE SYSTEM
AND SEPTIC TANK) RULES 2013
CERTIFICATE OF COMPLIANCE
Project Title : ______________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I, _____________________________________ (PE No: ___________________), hereby confirm that the stated sewerage
works :_____________________________________________ had been constructed in compliance to the approved
sewerage planning and approved design and Water Services Industry (Planning, Design and Construction of Sewerage
System and Septic Tank ) Rules 2013 and all conditions imposed by the Commission/ Sewerage Certifying Agency.
I certify that the stated sewerage works are fit to be taken over and operated by
___________________________________.
Signature of Qualified Person
Name of Qualified Person
(in block letters) :
I.C. No. :
Address :
Telephone No. :
Fax No. :
E-mail address :
SPAN Registration No. :
INDAH WATER KONSORTIUM SDN BHD
HANDOVER SIGN-OFF FORM
Title :
File No. :
Type of System :
Location :
I hereby certify that the above sewerage works have been constructed under my supervision and to the best of my knowledge,
the works has been constructed in accordance with the approved sewerage planning and approved design and Water
Services Industry (Planning, Design and Construction of Sewerage System and Septic Tank) Rules 2013 and I accept full
responsibility for the sewerage works and the asset is deemed fit for handover. I hereby undertake to issue certification of
completion within 7 days from the issuance of letter of completion by Certifying Agency
____________________________
(Signature & Stamp)
Qualified Person*
Name :
I.C :
PE No :
*The competent person recognized by the Commission
I/We hereby confirm that we have jointly inspected the sewerage works and confirm my/our intention to handover the above
system to __________________________. I/we hereby provide RM ____________________ of Bank Guarantee and agree
to make good the defects within the stipulated period, failing which, repair works will be carried out by relevant permit holders
and all costs including administration charges to be recovered from the Bank Guarantee in full. I/We hereby confirm that I/we
will bear any additional costs for the repair works in the event that the costs exceed the amount of the Bank Guarantee. I/We
hereby confirm that I/we have executed all necessary documents, to effect the transfer of the land on which the said sewerage
system is located to the Federal Government. I hereby undertake to surrender the mentioned sewerage system to the service
licensee within 7 days from the date of certificate of completion issued by Qualified Person.
________________________
(Signature)
Developer (owner)
Name :
I.C :
Address :
Tel No :
Fax No :
I/We on behalf of ___________________________ hereby confirm that we have jointly inspected the sewerage works on:
____________ and confirm that we hereby
Tick where appropriate;
Accept and take over of the system effectively from ___________________ (date)
Accept and take over of the system effectively from ___________________ (date) with minor defects to be
repaired within one month failing which, BG will be drawn down
Reject Reason: _______________________________________
the above system.
________________________
(Signature)
Indah Water Konsortium Sdn. Bhd.
Name :
I.C :
Address :
Tel No :
Fax No :
I/We, as the Certifying Agency for sewerage have facilitated the handover process of this sewerage system and hereby
confirm
Handover of the system from the developer to Service Licensee
Delay in takeover/ minor defect
Reject due to major defects.
Reasons:___________________________________________________
________________________
(Signature)
Certifying Agency (Name of Company)
Name :
Designation :
Unit Office :
EDISI 2 – PINDAAN
GARIS PANDUAN INDUSTRI PEMBETUNGAN MALAYSIA (JILID II) V1 JULAI 2013
6.2
SENARAI JADUAL
